Metabolic

Protection, choices, therapies, and prices

Medicare will usually pay for thyroid tests if a doctor deems it necessary. With the diagnostic tools, the doctor can understand whether someone has problems with their thyroid gland.

The thyroid in the neck produces hormones that regulate your metabolism. If a person has thyroid disease, they may experience weight control problems or cardiovascular complications.

This article examines thyroid dysfunction and describes how Medicare covers thyroid and other blood tests. It also looks at treatments and therapies for thyroid dysfunction and examines the cost.

There may be some terms used in this article that can help you choose the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain period of time before an insurer starts funding their treatments.
  • Co-insurance: This is a percentage of the cost of treatment that a person will need to self-finance. For Medicare Part B this is 20%.
  • Co-payment: This is a fixed dollar amount that an insured person pays for certain treatments. For Medicare, this usually applies to prescription drugs.

Thyroid dysfunction occurs when the thyroid gland produces either too much or too little thyroid hormone.

The thyroid has two lobes on either side of the windpipe below the voicebox or larynx. This endocrine gland makes two thyroid hormones, T3 and T4, which are chemical messengers that control metabolism, growth, and mood.

When the thyroid gland does not make enough hormones for the body, it leads to hypothyroidism or an underactive thyroid. If the thyroid produces too much hormone, the individual will have hyperthyroidism or an overactive thyroid.

Symptoms of hypothyroidism include:

  • fatigue
  • Joint and muscle pain
  • Cold intolerance
  • Weight gain

In hyperthyroidism, symptoms are related to an increased metabolic rate and include:

  • Swelling in the neck or goiter
  • Mood swings and nervousness
  • Hyperactivity
  • diarrhea
  • Muscle weakness

Both forms of thyroid dysfunction affect the body in different ways and can lead to a range of symptoms. However, people with minor thyroid dysfunction may not experience symptoms.

Learn more about common thyroid diseases here.

Different parts of Medicare cover the cost of thyroid testing and treatment.

Original Medicare

Original Medicare is Part A (health insurance) and Part B (health insurance).

Medicare Part A covers the cost of inpatient stays in a hospital, clinic, or other care facility. Medicare Part B includes medically necessary outpatient services, doctor visits, and prevention services, including diagnostic and blood tests.

In general, Medicare covers Part B thyroid testing if a doctor has ordered the test to diagnose or treat a disease.

However, Part A does cover costs when a person is in a hospital or care facility and a doctor orders a thyroid test during their inpatient stay. Medicare Part A will also cover the cost if the doctor recommends surgical removal of the thyroid.

Learn more about thyroid removal here.

Medicare Advantage plans

Individuals who qualify for Medicare can choose to be insured through Original Medicare (Parts A and B) or through a Medicare Benefit Plan.

While Medicare Advantage plans offer the same basic coverage as original Medicare, private insurance companies offer the plans, which means that they may offer additional benefits such as dental, visual, and hearing care. Many Advantage plans also offer coverage for prescription drugs under Part D of Medicare.

For more information on choosing a Medicare Advantage plan, click here.

Medicare Part D.

Medicare Part D is prescription drug insurance available to a person enrolled with Original Medicare. Private insurance companies offer these plans.

If a doctor prescribes medication because a person has mild thyroid disease, Medicare Part D pays the cost. People should review their plan’s list of medications called the Prescription to confirm thyroid medication coverage.

Learn more about Medicare Part D here.

The different treatments and therapies for thyroid dysfunction depend on the severity of a person’s condition. Medication is usually the first line of treatment.

Hypothyroidism

Treatment usually includes synthetic thyroxine, which replaces the T4 hormone. The dosage depends on the levels of thyroid stimulating hormone (TSH) in a person’s blood.

Doctors use blood tests to monitor hormone levels and then adjust the dose of thyroxine as needed.

Doctors may also recommend a meal plan that improves iodine absorption, including certain vegetables and soy products. Iodine is important for healthy thyroid function.

Learn more about TSH testing here.

Hyperthyroidism

Doctors prescribe drugs that either treat the symptoms of hyperthyroidism or control hormone production. Medications can include:

  • Beta blockers used to relieve symptoms such as anxiety and palpitations.
  • Antithyroid drugs, such as methimazole or propylthiouracil, to prevent the thyroid from making too much thyroid hormone.
  • Radioactive iodine that destroys active cells in the thyroid.

If the above treatments don’t work or are impossible, surgery to remove the thyroid gland may be an option.

Find out more about an overactive thyroid and Graves’ disease.

The cost of a thyroid blood test varies depending on the laboratory and location. Medicare covers most clinical diagnostic tests, including thyroid tests, but a person generally has some expense, as shown below.

Medicare Part A.

If a doctor orders a thyroid test while a person is in hospital, Medicare Part A pays the cost after a person has met their deductible. The Part A Deductible is $ 1,484 for each Benefit Period in 2021. A service period begins when you enter the hospital and lasts 60 days.

Medicare Part B.

Medicare Part B covers the total cost of thyroid testing. However, one person must meet the annual deductible of $ 203. Other costs include the monthly base premium for Part B, which is $ 148.50 in 2021.

Medicare Advantage plans

The cost of benefit plans varies. In addition to paying the standard Part B premium, a person enrolled in a benefit plan pays the plan premium. In 2020, the Advantage plan rewards averaged $ 25 per month.

Learn more about the cost of Medicare in 2021.

Most people generally do not have a cost for Medicare-covered clinical diagnostic tests, including thyroid tests. However, if a person needs help covering the cost of thyroid treatment, they can get assistance from Medigap or Medicaid.

Medigap

A Medigap plan helps a Medicare enrolled person pay for expenses such as copays, deductibles, and co-insurance that Medicare does not cover. Private insurance companies offer 10 Medigap plans with different levels of coverage.

Costs vary by location and plan, and can range from $ 64 to $ 500 per month.

Find out more about Medigap here.

Medicaid

Medicaid helps low-income households with limited resources access health services. The government finances this program, and individual states determine the eligibility criteria for income and wealth.

Learn more about Medicaid here.

Original Medicare (Part A and Part B) and Medicare Advantage plans provide the same level of coverage for thyroid testing. Medicare Part B covers the cost of an outpatient blood test, while MEdicare Part A covers the cost of a thyroid blood test as part of an inpatient hospital stay.

Both Medicare Part D and Medicare Advantage cover the cost of thyroid medication. Medicare Part A also covers the cost of surgery if a doctor deems it necessary to remove the thyroid gland.

The thyroid is a small hormone-producing gland in the neck. People can have problems when they make too much or too little thyroid hormones, which control metabolism and growth.

The information on this website can help you make personal decisions about insurance. However, they are not intended to be used as advice on buying or using any insurance or insurance product. Healthline Media does not conduct any insurance business and is not licensed as an insurance company or producer in any US jurisdiction. Healthline Media does not recommend or support any third party who could conduct the insurance business.

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